08/07/2023
Clinical Management of hidden Apical Carvatures by Prof. Gianluca Gambarini and Alessio Zanza
A 65 year old patient was referred for endodontic treatment of her second lower molar ( #37). She reported a history of spontaneous pain, swelling and dental fistula. Proceeding pulp vitality tests and radiographic examination, the tooth was diagnosed with symptomatic apical periodontitis. Looking at this pre-operatory radiograph, two information regarding this endodontic case should be detected:
- Obliterated pulp chamber and narrow canals
- The non-conventional anatomy of distal root
A traditional cavity access was performed using high speed diamond burs and the three orifices were localized with ultrasonic tips. K-file #08 was used to scout endodontic system of all roots, although it could not reach the apex in the distal canal. Pre-flaring and middle third instrumentation were gained with EdgeOne (EdgeEndo Global, Albuquerque, NM) reciprocating small (yellow) file, used with pecking strokes of 1-2mm, alternating with some brushing action to coronally flare canals. Frequent and copious manual irrigation was performed using solutions 5% sodium hypochlorite. Followed shaping of coronal and middle part, WL was determined with K-File #10 and shaping procedure were completed with martensitic X7 (EdgeEndo®, Albuquerque, NM) instruments in sizes 17 and 25, .04 taper.
Final irrigation was performed activating first an EDTA solution for 1 minute using sonic activation, followed by 1 min sonical activation of NaOCl. The root canal system was rinsed, dried and then obturated with an hydraulic single cone-technique and bioceramic sealer (BUSA, BC Sealer). Two periapical radiographs with different angulations were taken to verify treatment quality.
The instruments were chosen because their innovative manufacturing process which provides them with unprecedented flexibility and resistance to cyclic fatigue, allowing practitioners to perform procedures that would be difficult, if not unimaginable, with traditional non-heated files. More precisely, EdgeEndo® has focused research and development in the heat-treatment of NiTi files and has developed a proprietary process to produce FireWire™ files that exhibit 2 to 8 times the resistance to cyclic fatigue (and flexibility) than other NiTi files. The benefits of a flexible file seem obvious in complex curvature, but martensitic X7 files also offer another advantage: less “shape memory”. Although shape memory may seem beneficial, it can cause a file to “bounce back” in the tooth, putting lateral pressure on the canal wall, potentially leading to canal transportation or ledging.